'She ordered me to move after she cut the line and I have been here since dawn. I could not let her'

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In this photo taken Monday and made available Wednesday, a woman who identified herself as Chipure points at another woman at the Kakuma Mission Hospital in Turkana region in northern Kenya. The two mothers exchanged blows as they held their wailing infants in their arms after one of the women tried to budge in the long line for children to receive treatment for severe malnutrition.

KAKUMA, Kenya — The two mothers exchanged blows as they held their wailing infants in their arms after one of the women tried to cut in the long line for children to receive treatment for severe malnutrition.

The women faced off a second time after passing their children to onlookers amid the melee: The younger woman head-butted the other to the ground before hospital personnel intervened and separated them.

"She ordered me to move after she cut the line and I have been here since dawn. I could not let her," said one of the women who only identified herself as Chipure, a mother of eight children, who got a swollen lip from being head-butted.

The incident at the Kakuma Mission Hospital illustrates the growing desperation in northern Kenya, as a famine in neighboring Somalia that has killed tens of thousands draws an international aid effort. At least five people are reported to have died here in Kenya's Turkana region, one of the most remote and marginalized areas in the country, where people depend on herds of animals that are dying from the drought.

According to the U.N. children's agency, a little more than half of the population here consumes just one meal a day. The hunger crisis is so bad that families here are even sharing food supplements given to infants.

The temperature here can hit 104 degrees Fahrenheit (40 degrees Celsius), and 20 liters of water costs a third of John Ekidor's daily wage.

"The last time I took a bath was a week ago," said Ekidor, 33, who supports his family of eight by panning for gold. "Eating one meal a day is now a matter of chance."

At the Makutano Health Center, dozens of women line up to get their children a special peanut butter paste that is high in protein and carbohydrates.

Nyanyuduk Logiel, a 28-year-old mother of five, has brought her 3-year-old daughter Lokol back for follow-up care. The toddler is only about a third the weight she should be and can barely stand. She weighs only 12.35 pounds (5.6 kilograms).

In the nearly two weeks since little Lokol has been on the treatment, she's gained almost a quarter of a pound (100 grams) but has a long way to go before she reaches the weight she should be — 33 pounds (15 kilograms), says Jimmy Loree, the nurse in charge of the clinic.

Loree says the number of children being treated for acute malnutrition tripled from 21 to 68 in July, and he expects the figure will continue to rise.

"This year is really bad, it is really out of hand because if you see how people are living they have been depending on their animals that have been taken," Loree said.

School attendance is also down, from 200 children to 156 at one primary school, as families relocate in search of pasture and better grazing lands.

Droughts are common here, but over the last decade they have turned much more frequent. Before they occurred in five or 10-year cycles but now they are coming every two years — or even more frequently.

Dr. Joseph Epem, the medical officer in charge of largest government hospital in the region, says cattle rustling and border conflicts also have forced people living in areas where food can be grown to move to safer areas that are infertile.

He says his own family was forced to move from a fertile area near a river where they used to grow crops after their neighbor was killed. And last Friday, eight Turkana women were killed by Ethiopian Merille tribesmen in a dispute over land and pasture.

U.N. deputy emergency relief coordinator Catherine Bragg appealed to the international community for $1.3 billion needed urgently to save lives.

"Every day counts," she told the U.N. Security Council. "We believe that tens of thousands have already died. Hundreds of thousands face imminent starvation and death. We can act to prevent further loss of life and ensure the survival of those who are on the brink of death."

Bragg's office, which coordinates U.N. humanitarian efforts, said the famine is expected to spread to all regions of south Somalia in the next four to six weeks unless further aid can be delivered. The global body says it has received $1.1 billion, just 46 percent of the $2.4 billion requested from donor countries.

Bragg's appeal came as a U.N. food agency official warned that the number of people fleeing famine-hit areas of Somalia is likely to rise dramatically and could overwhelm international aid efforts in the Horn of Africa.

Luca Alinovi, the Food and Agriculture Organization's representative in Kenya, warned that the situation could become "simply unbearable" in the coming weeks if Somalis continue to abandon their homes in southern and central parts of the country — which are mainly under control of al-Shabab Islamist extremists — in search of food.

The United Nations estimates over 11 million people across East Africa need food aid because of a long-running drought exacerbated by al-Shabab's refusal to allow many humanitarian organizations to deliver aid in areas it controls, including the U.N. World Food Program, the world's major aid provider.

According to the U.N.'s Food Security and Nutrition Analysis Unit, Bragg said, "the current situation represents the most severe humanitarian crisis in the world today and Africa's worst food security crisis since Somalia's 1991-92 famine."

"We have not yet seen the peak of the crisis," she warned, citing high levels of severe malnutrition and deaths of children under age 5, combined with increasing cereal prices and a dry harvest season.

The Food and Agriculture Organization reported Wednesday that cereal prices in East Africa reached new peaks in several countries last month, worsening the already dramatic situation for millions of hungry people. The FAO said prices of milk also were at record or very high levels in most of the region.

Food prices have been driven higher by drought-plagued harvests and sharp increases in fuel and transport costs, according to the Rome-based agency.

In the past two months some 220,000 people have fled toward the Somali capital of Mogadishu and across the borders to Kenya and Ethiopia, where refugee camps are straining under the pressure of new arrivals. Almost 1 million people are displaced elsewhere in Somalia, the U.N. estimates.

"The possibility is basically having everybody who lives in that (famine) area moving out, which would be a disaster," FAO's Alinovi said, adding that transportation costs have doubled in recent months — evidence that there is growing pressure to leave.

Alinovi said FAO was working to prevent Somalis from abandoning their drought-stricken farms by paying them cash for small jobs, thus allowing people to remain. Once people leave their farms, they become dependent on aid for a very long time, he said.

Cash payments have been controversial in Somalia, because of the possibility that money might end up in the hands of militant groups like al-Shabab, who are fighting the weak central government in Mogadishu.

"It is a risk that can be handled," Alinovi said of the cash payments, warning that the alternative could be a sharp rise in the number fleeing. "If this becomes a massive number, like hundreds of thousands of people moving out, then this simple problem will be very difficult to bear."

Bragg told the Security Council that in areas under control of al-Shabab, the U.N. and its partners continue to negotiate for access.

In recent weeks, she said, some progress was made to scale up emergency operations by the International Committee of the Red Cross in central and southern Somalia. It is the only organization allowed to conduct food distribution in al-Shabab areas.

The U.N. children's agency, UNICEF, is also boosting its supplies for feeding centers, she said.

Since July, Bragg said, food is also being delivered to two newly accessible areas in the Gedo region.

But she said 3.7 million Somalis "are in crisis," 2.8 million of them in south central Somalia, and 3.2 million need "immediate, lifesaving assistance" including 1.25 million children.

Families from southern Somalia wait for food rations at Maalin refugee camp at Hawlwadag district in Mogadishu on Sept.15. Somalia is the country worst affected by a severe drought in east Africa and the Horn that has left some 13 million people in danger of starvation.
(Abdurashid Abikar / AFP - Getty Images)
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Somali refugees stand amid graves in a makeshift graveyard at Ifo camp, one of three camps that make up the sprawling Dadaab refugee complex in Dadaab town, northeastern Kenya, on Sept. 5.
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Somali refugee children sit in a circle with wooden boards inscribed with lines from the Quran, in the outskirts of Ifo camp, Dadaab refugee complex, northeastern Kenya, on Sept. 6.
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Somalian women queue for food at the Gift Of The Givers makeshift feeding center on Sept. 10 in Mogadishu. Gift Of The Givers is a South African-based disaster relief organization that is providing medical assistance and food aid to the famine-stricken people of Somalia.
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Tahliil Hussan holds an X-ray that shows the bullet still lodged in his abdomen at the Forlanini Hospital on Sept. 11 in Mogadishu, Somalia. A delegation from Gift Of The Givers Foundation is providing medical services to the famine-stricken in Somalia.
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A newly arrived Somali refugee boy tries to drink from a cup as he waits in line with his mother at a refugee reception center at Hagadera camp, one of three refugee camps that make up sprawling Dadaab refugee complex in Dadaab town, northeastern Kenya, on Sept. 5.
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A newly arrived Somali refugee woman sobs as she is confined inside a makeshift cell for not following the procedures at a refugee reception center at Hagadera camp, northeastern Kenya, on Sept. 5.
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Refugees who have been living on the outskirts of the camps in Hagadera rush to load their belongings onto trucks as they choose to relocate to the newly-opened Kambioos settlement, at the Dadaab refugee camp in Kenya on Aug. 29. The U.N. High Commission for Refugees regularly logs more than 1,000 new arrivals from Somalia each day as the region's famine crisis continues.
(Jonathan Ernst / Reuters)
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Men make donations to help the people of Somalia in Riyadh, Saudi Arabia, on Aug. 22. A famine has swept across the Horn of Africa, leaving at least 3.7 million Somalis at risk of starvation.
(Fahad Shadeed / Reuters)
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Weak and malnourished, Hassan Ali Musa, 4, sits with his father Iisa Ali Musa at the Banadir hospital in Mogadishu, Somalia, on Aug. 20. The U.N. estimates that more than 100,000 Somalis have fled to Mogadishu from famine and drought in the countryside.
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A famine refugee plays with a soccer ball next to a camp for people displaced by drought and famine in Mogadishu on Aug. 18.
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A security guard beats a woman for trying to enter a feeding center at a camp for people displaced by drought and famine in Mogadishu on Aug. 18.
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Somalis receive medical treatment at an outpatient hospital run by the African Union Mission in Somalia (AMISOM) in Mogadishu on Aug. 17. More than 10,000 people are treated monthly at AMISOM's three hospitals in Mogadishu. Ugandan doctors there say that increasingly many of the ailments, especially among children, are related to malnutrition.
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A security guard stands vigil outside a feeding center in Mogadishu on Aug. 16. The center, which serves cooked meals prepared using World Food Program aid, helps feed thousands of Somalis who have fled famine and drought in the countryside and have settled in makeshift camps throughout Mogadishu.
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An internally displaced Somali woman attends to her malnourished son at the Banadir hospital in Mogadishu on Aug. 16. Somalia called for the creation of a new force to protect food aid convoys and camps in the famine-hit country.
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Relatives of Hassan Abdulkadir Adan, third from left (rear), help to lower the body of his 7-year-old son into a grave in a refugee camp in Mogadishu, on Aug. 16.
(Farah Abdi Warsameh / AP)
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A mother mourns the death of her son at the Banadir hospital on Aug. 16, in Mogadishu. The hospital has been overwhelmed by new patients, as sickness spreads through camps for people displaced by drought and famine.
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A Somali boy receives a ration of cornmeal in the courtyard of a Somali non-governmental organization in Mogadishu.
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Editor's note:
This image contains graphic content that some viewers may find disturbing.

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Mulmillo closes the eyes of her two-year-old son Mahmud moments after he died from malnutrition and related complications at a local hospital in Mogadishu on Aug. 15. Mulmillo, her husband and three children fled their village in the Lower Shabelle region of southern Somalia and came to Mogadishu in search of a refuge from severe drought in the region.
(Roberto Schmidt / AFP - Getty Images)
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A group of Internally Displaced Persons (IDP) gather inside a courtyard after being designated to receive food aid from a Kuwaiti based Islamic charity in Mogadishu on Aug. 14.
(Roberto Schmidt / AFP - Getty Images)
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A Somali boy sings an Irish song to his classmates during class at the Illeys primary school in Dagahaley refugee camp, north of Dadaab, Eastern Kenya, on Aug. 11.
(Jerome Delay / AP)
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A Somali woman stands with several cans of water, ready to be transported by camel, in the town of Dhobley on Aug. 11.
(Phil Moore / AFP - Getty Images)
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Ethnic Turkana children sing and dance at Kalokutanyang Mobile School as aid workers arrive to inspect them in Kalokutanyang, Turkana, northwestern Kenya, on Aug. 9. A local official says that relief food has not reached many parts of the Turkana region where more than half the population is dependent on it, resulting in increasing child malnutrition.
(Dai Kurokawa / EPA)
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A Somali father with his daughter sits at the head of a line with other refugees at a registration center on Aug. 2, at Dagahaley refugee site, after being displaced from their home in southern Somalia by famine.
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Residents of Mwingi District fetch water from a muddy puddle, one of the only sources of clean water in Kenya on Aug. 2.
(Ken Oloo/ / Red Cross and Red Crescent via EPA)
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Somali refugees sit around a makeshift grave for fellow refugee Husein Mahalin, who died at the age of 20, due to illness outside the Ifo camp, one of three that make up the sprawling refugee camp in Dadaab, northeastern Kenya, on Aug. 1.
(Dai Kurokawa / EPA)
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A young boy from southern Somalia takes cover under a plastic sheet in a refugee camp in Mogadishu, Somalia, Sunday, July 31. Tens of thousands of famine-stricken Somali refugees were cold and drenched after torrential rains overnight pounded their makeshift structures in the capital, Mogadishu. Rains are needed to plant crops and alleviate the drought that is causing famine in Somalia but on Saturday night the rains added to the misery of refugees who live in structures made of sticks and pieces of cloth.
(Farah Abdi Warsameh / AP)
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Warehouse attendants carry bags of goods donated during a drive by the Somali community living in Kenya's capital, to aid Somali refugees in Kenya's northeast province at the Dadaab refugee complex, on July 29.
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A newly arrived Somali refugee is forced out of the queue outside a reception centre in the Ifo 2 refugee camp in Dadaab, near the Kenya-Somalia border, on July 28.
(Thomas Mukoya / Reuters)
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Men unload the first airlifted humanitarian food aid at the Aden Abdulle Osman International Airport in Mogadishu, Somalia, on July 27. The World Food Program airlifted 10 tons of emergency supplies to Mogadishu to feed thousands of malnourished children in drought-hit Somalia. Somalia is the country worst affected by a prolonged drought in Eastern Africa -- the region's worst in 60 years -- that has put some 12 million people in danger of starvation and spurred a global fund-raising campaign.
(Feisal Omar / AFP - Getty Images)
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Children drink water from the same place as cattle at Liboi, Kenya, on July 27. UNICEF says it is trying to vaccinate more than 300,000 children in Kenya in an emergency program designed to prevent an outbreak of disease as refugees stream into northern Kenya from famine-hit Somalia.
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A doctor examines Mihag Gedi Farah, a seven-month-old child with a weight of 7.5lbs (3.4kg), in a field hospital of the International Rescue Committee, IRC, in the town of Dadaab, Kenya, July 26. The U.N. will airlift emergency rations this week to parts of drought-ravaged Somalia to keep hungry refugees from dying along what an official calls the "roads of death." Tens of thousands already have trekked to neighboring Kenya and Ethiopia, hoping to get aid in refugee camps.
(Schalk Van Zuydam / AP)
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Used food tins are stacked at a field hospital of the International Rescue Committee, IRC, in Dadaab, July 26.
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A malnourished child from southern Somalia is weighed in Banadir hospital in Mogadishu, July 24. The World Food Program can't reach 2.2 million Somalis in desperate need of aid in militant-controlled areas of Somalia, meaning refugee camps in nearby Kenya and Ethiopia are likely to continue seeing thousands of new refugees each week.
(Farah Abdi Warsameh / AP)
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A general view of the Dadaab Refugee camp in eastern Kenya on July 23, where the influx of Somali's displaced by a ravaging famine remains high. 12 million people are struggling from the worst regional drought in decades, affecting parts of Ethiopia, Kenya, Somalia, Djibouti and Uganda.
(Tony Karumba / AFP - Getty Images)
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Somalian refugees disembark a bus in the registration area of the IFO refugee camp which makes up part of the giant Dadaab refugee settlement, July 23. The refugee camp at Dadaab, located close to the Kenyan border with Somalia, was originally designed in the early 1990s to accommodate 90,000 people but the UN estimates over 4 times as many reside there.
(Oli Scarff / Getty Images)
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An aid worker using an iPad films the rotting carcass of a cow in Wajir near the Kenya-Somalia border, July 23. Since drought gripped the Horn of Africa, and especially since famine was declared in parts of Somalia, the international aid industry has swept in and out of refugee camps and remote hamlets in branded planes and snaking lines of white 4x4s. This humanitarian, diplomatic and media circus is necessary every time people go hungry in Africa, analysts say, because governments - both African and foreign - rarely respond early enough to looming catastrophes.
(Barry Malone / Reuters)
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A dust storm blows as newly arrived Somalian refugees settle on the edge of the Dagahaley refugee camp, which makes up part of the giant Dadaab refugee settlement, July 23.
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A Somalian refugee helps to dig a latrine on the outskirts of the IFO refugee camp which makes up part of the giant Dadaab refugee settlement on July 23.
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Somalian refugees wait in the registration area of the Dagahaley refugee camp, part of the Dadaab refugee settlement on July 23.
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Somalian refugees' documents are checked at the entrance to the registration area of the IFO refugee camp, on July 23, in Dadaab, Kenya.
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A mother washes her malnourished child in the Medecins Sans Frontieres (Doctors Without Boders) hospital on July 22, in the Dagahaley refugee camp in Dadaab, Kenya.
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Drought-stricken camels drink water from a tank near Harfo, northwest of Somalia's capital Mogadishu, July 20. The United Nations declared famine in two regions of southern Somalia, and warned that this could spread further within two months in the war-ravaged Horn of Africa country unless donors step in.
(Thomas Mukoya / Reuters)
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Farhiya (centre) holds her 7-year-old sister Suladan by the hand as they follow their mother and brothers at the reception center of the Dolo Ado refugee camp near the Ethiopia-Somalia border on July 19. Refugees are being housed at the transit center while a new camp is being set up by the Ethiopian goverment and international aid organizations. Thousands of Somalis have fled in recent months to neighbouring Ethiopia and Kenya in search of food and water, with many dying along the way.
(Roberto Schmidt / AFP - Getty Images)
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Somalis fleeing hunger in their drought-stricken nation walk along the main road leading from the Somalian border to the refugee camps around Dadaab, Kenya, on Wednesday, July 13. More than 11 million people in the Horn of Africa are confronting the worst drought in decades and need urgent assistance to stay alive, U.N. Secretary-General Ban Ki-moon said.
(Rebecca Blackwell / AP)
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A woman from southern Somalia struggles to build a makeshift shelter from tree branches at a new camp in Mogadishu, Somalia, on July 13.
(Mohamed Sheikh Nor / AP)
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Osman Ali Aliyow Mursal digs a burial plot among other graves for his four-year-old son, Aden Ibrahim, as men prepare to pray over the boy's body, wrapped in a plastic mat, on the outskirts of Ifo II Camp, outside Dadaab, Kenya, on Tuesday, July 12. Doctors were unable to save Aden, who died of diarrhea-related dehydration after four days of inpatient care. U.N. Refugee Chief Antonio Guterres said Sunday that drought-ridden Somalia is the "worst humanitarian disaster" in the world, after meeting with refugees who endured unspeakable hardship to reach the world's largest refugee camp in Dadaab, Kenya.
(Rebecca Blackwell / AP)
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Aden Salaad, 2, looks up at his mother as she bathes him in a tub at a Doctors Without Borders hospital, where Aden is receiving treatment for malnutrition, in Dagahaley Camp, outside Dadaab, Kenya, on Monday, July 11.
(Rebecca Blackwell / AP)
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Somali refugees line up for food rations at a receiving center in Dagahaley Camp, outside Dadaab, Kenya, on Saturday, July 9.
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A Somali child from southern Somalia holds his brother as they wait outside a ruined building before making their way to the internally displaced persons camps in Mogadishu, Somalia, on Friday, July 8.
(Farah Abdi Warsameh / AP)
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A refugee from Southern Somalia carries her baby and her belongings, as she makes her way to a camp in Mogadishu, Somalia, on Monday, July 5.
(Farah Abdi Warsameh / AP)
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Editor's note:
This image contains graphic content that some viewers may find disturbing.